Predicting Need – Physical and Sensory Disability

Disabled people in Barnet are a significant proportion of the population in Barnet who we know experience poorer life chances and outcomes than non-disabled people. The definition of ‘disability’ here is taken from the Disability Discrimination Act 1995: “A physical or mental impairment that has a substantial and long term impact on the ability of a person to carry out normal day to day activities. Included within this definition in Barnet are adults aged 18 plus affected by physical disability, long term illness/ conditions and sensory impairment.”

In Barnet we can expect:-

13,785 households in Barnet that have support needs due to a physical disability

1890 people with a neurological condition requiring help with daily living

4590 carers of people with a neurological condition

745 people with acquired brain injury

820 registered blind and 730 partially sighted people

1485 people who are registered deaf or hard of hearing

40% of people with a learning disability also have a hearing impairment

There a wide variety of long term neurological conditions and people have very different experiences. The time course of conditions also varies widely. The average time between diagnosis and death for someone with motor neurone disease is 14 months, while someone with multiple sclerosis may live with the condition for decades. Even within specific conditions, the needs of individuals, for example for social care support, vary widely. The diagnosis or onset of these conditions generally marks the beginning of profound changes in the life of the person and the lives of their carer, family and friends. It may affect relationships, career prospects, income and expectations for the future. Nationally neurological conditions account for 20% of acute admissions and are the third most common reason for seeing a GP. It is therefore essential that health and social care organisations work within a long term conditions model to provide effective support to enable people to live as independently as possible in their own homes.

According to the Housing Needs Survey, people with physical disability make up the largest group who has support needs (74%).

There has been an annual increase in initial contacts to social services, progressing through to assessment from around 150 in 2004/5 to nearly 600 in 2007. The demand is affected by earlier discharges from hospital, general demographic growth and accommodation need which impacts upon the demand for services for younger adults with physical and sensory disabilities.

The factors that affect health outcomes and independence affect disabled people disproportionately. Compared with non-disabled people, disabled people are

more likely to live in poverty-the income of disabled people is, on average, less than half that earned by non-disabled people

less likely to have educational qualifications

more likely to be economically inactive – only one in two disabled people of working age are currently in employment, compared with four out of five non-disabled people

more likely to experience problems with hate crime or harassment – a quarter of all disabled people say that they have experienced problems with housing – nine out ten families with disabled children have problems with their housing

more likely to experience problems with transport – the issue given most often by disabled people as their biggest challenge

As well as a predicted increase in the adult population which will affect demand in the future, age is the single most common reason why someone might be hard of hearing and the increases in the numbers of older people will increase the demand for specialist sensory impairment services. Increases in demand are also being affected by:

A rising increase in the prevalence of disability among children, partly due to the increase survival of pre term babies

The increase in drug and alcohol use, resulting in disability or cognitive impairment

Rising public expectations

Ethnicity has an impact on demand in Barnet as population estimates set out in the earlier sections show the growth in the younger age groups and this affects health in particular ways. For example

High blood pressure and stroke is more common in people from Africa and the Caribbean

The prevalence of Deafness within the Asian community is 4-5 times higher than the national average across the population the incidence of diabetes is especially high in people from Africa the Caribbean and South Asia and Hepatitis B is especially prevalent in people from South East Asia.

Sickle cell disorder is commoner in those of African-Caribbean descent and thalssaemia in Asia and Mediterranean communities.

Responding to changing demand

Barnet has adopted the social model of disability. This recognises that many of the difficulties / barriers that arise for disabled people, notwithstanding the fact of their disability, are largely attributable to attitudes and structures in society. The six priorities for action identified in the commissioning strategy are focused on an agenda for change which focuses on inclusion, rights and choice, moving away from specialised service provision towards facilitating access to mainstream services with a strong focus on addressing inequalities. A cornerstone of this is the development of individualized budgets. Another is partnership with housing agencies.

There are specific initiatives and targets which rely on partnership between social care and the NHS including improved access to rehabilitation for individuals with a long term neurological condition to achieve the best possible outcomes, including a reduction in wait times for individuals to specialist facilities in line with national guidance and to increase access to specialist therapists in the community and to vocational rehabilitation in the community. There are specific targets to improve the balance of those people who live in registered care and those supported intensively to live in their own homes.

The service structures are starting to change; the equipment service has been changed to provide a more responsive service with improved coverage and response times.

Currently Barnet has the highest number of service users overall receiving Direct Payments. The most recent review of the Direct Payments Advisory Service highlights improved performance and the relatively high number of people from black and minority ethnic backgrounds in receipt of direct payments. The report also shows that the Direct Payments Advisory Service is highly valued by service users evidenced by 98% customer satisfaction. The service has targets including increasing service user involvement in the management and implementation of direct payments and facilitating change and delivery of individual budgets as part of the Delivering Choice and Independence Programme. The outcomes for people using this increased flexibility of care arrangements are clearly demonstrated in the user survey. The high level of Direct Payments and the high value placed on this method by service users are helping to promote the cultural and organisation change required to deliver the overall vision of independence and choice in Barnet.

Barnet is committed to facilitating access to paid work for younger adult service users with a physical disability. Daycare is gradually being transformed from being focused on buildings providing segregated services so that investment can be made into improving access to activities in the community including leisure facilities, libraries and education which improves the physical fitness of people, improve choices and enhance life opportunities. Key local service developments in the borough include the transition of the Flightways Resource Centre into becoming a Centre for Independent Living for adults with physical or sensory disability.

Barnet is developing an enablement process which provides more intensive help when people first get referred for assessment as part of its core remodelling. This also includes transforming homecare services to provide more intensive short term support which maximises people’s independence and reduces reliance on long term care. For those who do need longer term services they will be encouraged to have direct control in how their care and support needs are met through support planning and brokerage. These options will need to continue to develop to effectively offer viable alternatives to residential / nursing care, in accordance with preference of people to remain living within community settings. This will support admission avoidance and contribute to reduction in overall emergency bed days used.

Key Messages

The disability is predominantly whole community agenda, focused on rights inclusion and choice moving away from specialist provisions towards facilitating access to mainstream services and to the community in general with a strong focus on addressing inequalities.

Health and social care organisations are developing a commissioning system which supports personalised care. The different agencies working across the health social care and voluntary sector will work need to work in effective partnership to continue to develop seamless services and to effectively target local resources to best effect.

Access to suitable housing and opportunities for paid employment is key areas for continued development.